Download Early Intervention in the Context of Psychological Injury

injurytreatment
Occupational injury management
Early Intervention, Injury
Resolution & Sustainable RTW
Outcomes.
Presented by:
Mr. Fred Cicchini, Chief Operations Manager
September 2013
Session Objectives
 Early Intervention in the RTW Context
 Injury Treatment Pilot project results
 EI in the Context of Psychological Injury
 Application of best practice EI in the Comcare context
 Next Steps
EI ‘Purpose’ Effective
Barrier Management
EI Context & Benefits
“Traditional”
Approach to EI
* Focus on speed of notification Not speed or
intervention
* Person Centred Intent that
* Is seldom systemic
* Delivered but not measured
* Lacks clarity in expectation and responsibility
* Lack of uniformity can create delay in claim
notifications
* Inconsistent focus on accurate diagnosis
* Lacks momentum for objective medical
management
* Delays in obtaining clinical opinions & EBT
* Workplace not assessed and suitable duties not
appropriate and / or progressive
* Extended periods of unfit certification
* Extended periods of claim durations
Best Practice
Approach to EI
EI in the RTW
Context
Industry
Performance
2008 / 2009

 45% of injured workers remained off work for more
than 4 weeks
 For the 35% who were off work between 4 and 26
weeks.
Injury Treatment
Early Intervention
Pilot Study
Pilot Study
* Multi-national organisation employing
over 30,000 staff nationally
* 200 claims registered per month
nationall
* Staff work across as range of industries
* Partnered with Injury Treatment for their
NSW business in January 2011 with
rollout occurring in June 2011
Pilot Study –
2011/12
Early Intervention in
the Context of
Psychological Injury
Psychological
Framework
* The Australian population rated Mental Illness as
the third most critical concern (behind the
economy and environmental concerns) facing the
nation.
* 1/5 adults and 1/4 adolescents have experienced a
diagnosable illness in the last 12 months
* Mental Health is the 3rd most prevalent injury /
illness in Australia (1st = Cardiovascular; 2nd =
Respiratory Disease). Depression is the 4th most
common illness presented to GPs in Australia.
* Its recognised that the vocational context “may”
act as a ‘trigger’ for mental health concerns,
However...
As work is approx. 25% - 35% of our waking
life statistically the employment context is
one of the most likely domains where
psychological dysfunction may manifest!
Risk Implications
Depression:
* 6.7% of Australian Employees suffer from a diagnosable
Clinical level of depression each year;
* 3 to 4 days off work per month for each person
experiencing depression
* $9,660 in absenteeism and lost productivity costs
per full time employee with untreated depression
each year ($650,000 per annum per 1,000
employees).
* 65 % of these employees
don't disclose or seek
treatment but do become involved in complicated
conflict, performance or attendance issues;
* Statistically the duration of influence for those who went
on claims was longer then those who did not (systemic
reinforcement).
* Undiagnosed Depression accounts for $4.3 billion
dollars or 12 million days in lost productivity.
(Exclusive of the costs of compensable claims such as
workers compensation or income protection).
Psychological Injury
Psychological Injury
Circumstance where one’s normal
cognitive, behavioural or emotional
functioning is overwhelmed by demands.
Normative and effective strategies for self
regulation become overwhelmed and
prove less effective.
The EI Context
• Reduce Overwhelm;
• Increase access to normative and
effective strategies for self regulation;
• Remain focused on a clinical, vocational
and employment context
Application of best
practice EI in the
Comcare Context
Application Early
Intervention?
Goal Directed Macro & Tactical System
1.Timely Identification & Notification;
2.Effective Categorisation of Risk;
3.Evidence Based Resources & Intervention;
4.Barrier Mitigation & Management
Cultural Commitment
1.Systemic Employee Engagement;
2.Effectively Informed Teams;
3.Prepared & Empowered Leaders
4.An Organisational Culture open to Early Intervention
Pre EI Cultural
Platform
A Systemic Culture of Innovation,
Continuous Improvement and Personal
Accountability Supported through Clinical
Education
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Management ‘Master Class’ on EI & Mental Health
Leadership Resilience building
Resilience Building
Stressors V’s ‘Stress’ & Workplace ‘Stressor’
Management
Accountable Interpersonal Communication
Mental Health Awareness
Managing Mood
Managing Psychological Hygiene Factors (fatigue,
sleep, lifestyle, addiction etc.)
Resilience EI Culture
Necessary Leadership
Qualities
Self aw areness
Definition
Hallmarks
Ability to recognize and understand
your moods, emotions and drivers,
as well as their effect on others
Self confidence
Realistic self assessment
Self deprecating sense of humour
Self regulation
Ability to control or redirect
disruptive impulses and moods
The propensity to suspend
judgment – to think before acting
Motivation
A passion to work for reasons that
go beyond money or status
Pursuing goals with energy and
persistence
Empathy
Ability to understand the emotional
make up of other people
Skill in treating people according to
their emotional reactions
Social skill
Proficiency in managing
relationships and building networks
Ability to find common ground and
build rapport
Trustworthiness and integrity
Comfort with ambiguity
Openness to change
Strong drive to achieve
Optimism even in the face of failure
Organisational commitment
Expertise in building and retaining talent
Cross cultural sensitivity
Service to clients and customers
Effectiveness in leading change
Persuasiveness
Expertise in building and leading teams
Early Indicators
Physical
Behavioral
Emotional
Cognitive
Designing Early
Intervention
Models and Risk
Identification
EI System Design
• Gap Analysis & Diagnosis of leadership
and system capability
• Data Review
• Development & Design of clear policy
and guidelines for early intervention
• Delivery of necessary training to people
management skills and resources
• Monitor & manage external resource
• Review the results
PHASE ONE SYSTEM
DESIGN
INCIDENT
IDENTIFCATION &
NOTIFCATION STAGE
Incident & Notification
The Organisation
* Are we engaging the employee?
* What is our process for identifying those
at risk of injury or suffering from nonwork related diseases / injuries?
* What is the skill level of supervisors to
identify and raise a concern, what are
the early warning signs?
* What do we consider to be a case risk?
* What is our process when somebody
injures themselves or becomes unwell?
* What would be the best resource &
when – EAP / MAP?
* What are our timeframes that this
should occur within?
Incident &
Notification
The Employee
• Can an employee self refer pre injury &
how?
• What avenues do employees take and
are they educated in reference to EI
requirements?
• Are warning signs ‘acceptable’ in
culture?
• Is an early notification framed as a
collaborative or adversarial engagement?
• Are teams supported to be empathetic
and functional should the need for
disclosure arise?
• Is disclosure managed in a frame that
demonstrates an employee focus?
• Do employees understand that RTW is
not necessarily subsequent to
treatment?
PHASE TWO SYSTEM
DESIGN
CATEGORISATION &
ANALYSIS OF CASE RISK
Case Risk Screening
– The Organisation
* Are we engaging the employee?
* Are your Screening Tool accessible to all
managers?
* Does our policy and processes on early
intervention define how to administer
screening tools?
* Have our leadership team been trained
on how to administer tools?
* Have leaders been coached to correct
for personal bias, discomfort and self
interest?
* Do screening tools allow for targeted
expenditure - treatment, EAP,
rehabilitation?
* In review do screening tools deliver best
practise interventions for the workforce?
Case Risk Screening
The Employee
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Personal Awareness?
History?
What has occurred leading up to this?
What is the employees current work
status?
What key symptoms are present?
Communication capability – employee &
supervisor?
Documentation & collaboration?
+/ - medical involvement?
PHASE THREE SYSTEM
DESIGN
APPLICATION OF
EVIDENCE BASED
RESOURCE
Application Of
Evidence-Based
Resource – The
Organisation
Are we engaging the employee?
Who makes this decision?
Is our decision evidence based?
What timeframe have we set?
Does our policy define clear guidelines
for type and duration of supplier
engagement
* Do we use early intervention
assessments?
* Do our suppliers (medical, treatment,
EAP, rehabilitation) understand our
business and is their service customised
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Application Of
Evidence Based
Resource – The
Employee
* Do we ask for multi axial diagnosis and
diagnostic code?
* Are we curious and insightful about
diagnosis?
* Do we engage treating professionals to
empower through information?
* Do we ensure that viable RTW goals
frame an accepted treatment plan?
* Ensure treatment goals are SMART
What Can We Influence?
Diagnosis
* Accurate and comprehensive diagnosis
paramount
* Comprehensive medical management to
minimise the duration of symptoms
* Return to work expectations managed
through education regarding diagnosis
and prognosis
* Subsequent return to work expectations
managed
* The identification and management of
relevant non work related psychosocial
factors through screening and
counselling services
Ramifications Of
Misdiagnosis
* Delayed recovery
* Inappropriate medical restrictions –
time off work
* Unnecessary costs – medical and lost
time
* Psycho-social implications
* Operational implications to the
employer
Diagnostic Influence on
Return To Work
* Accurate diagnosis guides appropriate
treatment
* Diagnosis enables appropriate education
regarding injury
* Diagnosis guides appropriate specialist
referral
* Diagnosis guides selection of suitable
duties
* Diagnosis guides appropriate response
with regard to timeframes for absence
from and return to work
Resilient in Injury
Management
Expected Outcomes
of Effective EI
* Diagnosis and medical intervention =
RTW success
* Early psychosocial screening may
identify those at risk of long term
disability
* Subsequent early psychological
intervention may curb long term
disability
* Systematic identification of workers at
risk of developing biological,
psychological and social barriers to
return to work
* Targeted / consistent referral for
appropriate services
Expected Outcomes
of Effective EI
* Minimisation of treatment and rehab
costs associated with inappropriate or
more intensive services than required;
* Removes the subjectivity of individual
Case Managers’ = uniform system &
consistency in barrier assessment and
mitigation.
* Reduced suitable duties durations =
reduced operational costs
* Reduced claims durations, durable RTW
rates
* Maintaining / increasing productivity
Summary
Best Practice EI systems in a
Psychological Injury context
facilitates immediate
identification, analysis and
implementation of strategies to
ensure:
• Clear responsibilities and
communication
• Accurate diagnosis and evidence
based treatment
• Appropriate and objective medical
management
• Occupational rehabilitation / EI
intervention
• Consistency in rehab, medical and
treatment spend
• Quick resolution
Next Steps